Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Popul Health Manag. 2022 Jun;25(3):309-316. doi: 10.1089/pop.2021.0172. Epub 2021 Oct 4.
Evidence suggests that the patient-centered medical home (PCMH) model of primary care improves management of chronic disease, but there is limited research contrasting this model's effect when financed by a single payer versus multiple payers, and among patients with different types of health insurance. This study evaluates the impact of a statewide medical home demonstration, the Maryland Multi-Payer PCMH Program (MMPP), on adherence to antihypertensive medication therapy relative to non-PCMH primary care and to the PCMH model when financed by a single payer. The authors used a difference-in-differences analytic design to analyze changes in medication possession ratio for antihypertensive medications among Medicaid-insured and privately insured non-elderly adult patients attributed to primary care practices in the MMPP ("multi-payer PCMHs"), medical homes in Maryland that participated in a regional PCMH program funded by a single private payer ("single-payer PCMHs"), and non-PCMH practices in Maryland. Comparison sites were matched to multi-payer PCMHs using propensity scores based on practice characteristics, location, and aggregated provider characteristics. Multi-payer PCMHs performed better on antihypertensive medication adherence for both Medicaid-insured and privately insured patients relative to single-payer PCMHs. Statistically significant effects were not observed consistently until the second year of the demonstration. There were negligible differences in outcome trends between multi-payer medical homes and matched non-PCMH practices. Findings indicate that health care delivery innovations may yield superior population health outcomes under multi-payer financing compared to when such initiatives are financed by a single payer.
有证据表明，以患者为中心的医疗之家（PCMH）模式改善了慢性病的管理，但对于单一支付者与多个支付者为该模式提供资金的情况，以及在具有不同类型健康保险的患者中的效果，相关研究有限。本研究评估了一项全州范围的医疗之家示范项目——马里兰州多支付方 PCMH 计划（MMPP）对药物治疗依从性的影响，相对于非 PCMH 初级保健以及单一支付者为 PCMH 模式提供资金的情况。作者使用差异中的差异分析设计，分析了 MMPP 中初级保健实践（“多支付方 PCMHs”）、参与由单一私人支付者资助的区域 PCMH 计划的马里兰州医疗之家（“单一支付方 PCMHs”）以及马里兰州非 PCMH 实践中，接受医疗补助保险和私人保险的非老年成年患者的降压药物药物占有比的变化。基于实践特征、位置和聚合提供者特征，使用倾向评分对多支付方 PCMH 进行匹配，以找到比较地点。与单一支付方 PCMH 相比，多支付方 PCMH 对医疗补助保险和私人保险患者的降压药物依从性表现更好。直到示范的第二年，才观察到一致的统计学显著效果。多支付方医疗之家与匹配的非 PCMH 实践之间的结果趋势差异可以忽略不计。研究结果表明，与单一支付者为这些计划提供资金相比，在多支付者融资下，医疗保健服务创新可能会带来更优的人群健康结果。
